Surgical Outcomes in Splenic Flexure Colon Cancer

Surgical management of splenic flexure colon cancer presents unique challenges due to its dual vascular supply and variable lymphatic drainage. Approaches range from extended hemicolectomies—removing large segments of colon—to segmental resections focused on the tumour-bearing flexure. Minimally invasive techniques, including laparoscopic complete mesocolic excision with central vascular ligation, have gained traction. Key endpoints include oncological clearance (R0 resection), lymph node harvest, operative morbidity and long-term survival. Recent advances have refined anatomical understanding of arterial variants and mesenteric pathways, enabling more tailored resections that balance radicality with preservation of bowel function and reduction of postoperative complications.

Research from Nature Portfolio

Recent studies have compared extended hemicolectomy with more limited resections centred on the splenic flexure. One large analysis demonstrated that segmental resection, extended right and extended left hemicolectomies achieve equivalent five-year overall and disease-free survival, R0 resection rates above 98%, and adequate lymph node harvest, while partial resections minimise operative trauma and rates of severe postoperative complications. These findings support the oncological safety of more conservative resections in elective settings.

Surgical Outcomes in Splenic Flexure Colon Cancer publication trend

The graph below shows the total number of articles in surgical outcomes in splenic flexure colon cancer across all publications each year (not limited to Nature Index journals).

Technical terms

Extended right colectomy: Removal of the ascending, transverse and part of the right colon to include splenic flexure tumours, with high ligation of the superior mesenteric vessels.

Segmental colectomy: Limited resection of the splenic flexure segment with targeted removal of adjacent lymphatic tissue.

Complete mesocolic excision (CME): Technique involving dissection along embryological planes to remove the colon and intact mesocolic envelope, preserving fascial integrity.

Central vascular ligation (CVL): Division of feeding arteries at their origin to maximise lymph node clearance.

Accessory middle colic artery (aMCA): Variant vessel supplying the splenic flexure, present in around one-third of patients, relevant for comprehensive lymphadenectomy.

References

1. Treatment of splenic flexure colon cancer: a comparison of three different surgical procedures: Experience of a high volume cancer center. Scientific Reports (2019).
2. Short- and long-term outcomes after surgical treatment of 5918 patients with splenic flexure colon cancer by extended right colectomy, segmental colectomy and left colectomy: a systematic review and meta-analysis. Frontiers in Oncology (2024).
3. A three-dimensional computed tomography angiography study of the anatomy of the accessory middle colic artery and implications for colorectal cancer surgery. Surgical and Radiologic Anatomy (2020).
4. Segmental resection of splenic flexure colon cancers provides an adequate lymph node harvest and is a safe operative approach – an analysis of the ACS-NSQIP database. Surgical Endoscopy (2022).
5. Laparoscopic complete mesocolic excision with central vascular ligation for splenic flexure colon cancer: short- and long-term outcomes. Surgical Endoscopy (2021).
6. A multicenter cohort study on mapping of lymph node metastasis for splenic flexural colon cancer. Annals of Gastroenterological Surgery (2022).